ERCP: a review of technical competency and workload in a small unit

ERCP is increasingly performed not only in large referral centers but also in smaller units. We sought to analyze the success rates of selective cannulation and intervention using the cumulative sum method and to document the workload in a small unit.

Indications, results, and interventions performed by one endoscopist were recorded for all patients undergoing ERCP at Dunedin Hospital. Selective cannulation and successful intervention were used as outcome measures and, using the cumulative sum method, compared to a target value of 90%.

Over an 8-year period, 532 ERCPs were performed. Overall 91% and 81% of selective cannulation and interventions respectively, were successful. The cumulative sum method plot shows that satisfactory outcomes for selective cannulation were obtained after some 100 to 120 procedures and after some 120 interventions. ERCP was normal in 171 (32%) patients, stones were found in 169 (32%), and strictures in 81 (15%) patients.

The cumulative sum method is a valuable tool to compare individual performance with a nominated target value and to ensure that an acceptable outcome is achieved and maintained. These results show that small units can develop and maintain expertise in ERCP if procedures are performed regularly.